Smith v. Burwell

No. 14-1519 (APM) (D.D.C.), filed Sept. 5, 2014

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Amicus information: Amici are the Center and the National Health Law Program. They are supporting the claim of Medicare beneficiaries that they should be covered for a form of testing that would assist in the diagnosis of patients suffering from dementia.

Issues: Whether a diagnostic test (PET beta-amyloid scans) should be covered because it is “reasonable and necessary for the diagnosis or treatment” of dementia.

Relief Sought: Reversal of the adverse coverage decisions and enjoining of the National Coverage Determination that denies coverage of the PET beta-amyloid scans.

Status: The parties have fully briefed cross-motions for summary judgment. The Center’s amicus brief explains the similarity between the analysis that the government is making in this case (essentially requiring that the scans provide treatment as well as diagnosis) and the discredited “Improvement Standard” that is the focus of the Jimmo case. The government opposed the filing of the Center’s brief, and the Court has not yet ruled on whether it should be filed.